Treatment of multiple recession-type defects in patients with esthetic demands

When multiple recession defects affecting adjacent teeth in esthetic areas of the mouth are present, patient-related considerations suggest the selection of surgical techniques that allow all gingival defects to be simultaneously corrected with the soft tissue close to the defects themselves. The aim of the present study was to evaluate, with respect to root coverage, the effectiveness of a new surgical approach to the coronally advanced flap procedure for the treatment of multiple recession defects in patients with esthetic demands.

Twenty-two young systemically and periodontally healthy subjects with at least 2 recession-type defects affecting adjacent teeth in esthetic areas of the mouth were enrolled in the study. All recessions were Miller Class I or II. In each patient, all present recessions were treated at the same time with a modification of the coronally advanced flap technique. The clinical re-evaluation was made 1 year after the surgery.

A total of 73 recessions (mean recession depth 2.8 mm) were treated; mean number of gingival recessions in each subject was 3.4. At the 1-year examination, on average, 97% of the root surface was covered with soft tissue and 64 defects (88%) showed complete root coverage. Complete root coverage in all recessions was achieved in 16 out of 22 patients (73%), and no statistically significant relationship was found between the root coverage results and the number of recession defects treated in each patient. A statistically significant increase of keratinized tissue (0.6 mm) was observed after 1 year; this increase was inversely correlated (P <0.001) with the amount of presurgical keratinized tissue. The multiple regression model showed that the final result, in terms of root coverage, was significantly affected by the initial recession depth and by the amount of presurgical keratinized tissue. Greater reductions in recession depth were observed in the cases with worse initial conditions and with lesser amount of keratinized tissue apical to the recession defect.

The results of the present study demonstrated that the proposed surgical technique was very effective for the treatment of multiple gingival recessions affecting teeth in esthetic areas of the mouth and that these successful root coverage results could be achieved irrespective to both the number of recessions simultaneously treated during the surgical intervention and the presence, before surgery, of a minimal amount of keratinized tissue apical to the defects.